Spinal cord bypass surgery using peripheral nerve transfers to restore elbow flexion in a pediatric patient with central cervical cord syndrome

Background: Spinal cord bypass surgery (SCBS) is a procedure for restoration of organ function following spinal cord injury (SCI). Nerve transfer (neurotization) is a common operation in patients with brachial plexus injury. It can be also used for SCBS in patients with SCI. Objective: To report operative method and surgical outcome of nerve transfer in a patient with cervical SCI Material and Method: The authors report a 6-year-old patient with central cervical cord injury without spontaneous neurological recovery. Physical examination showed asymmetrical motor deficit of both upper extremities. Results: Double fascicular transfer for elbow flexion was performed on the right side and spinal accessory to musculocutaneous nerve transfer with sural nerve graft interposition was done in order to restore left elbow flexion. The patient could perform right elbow flexion (MRC Grade 3) at five months following the operations. Conclusion: To the authors’ knowledge, this case is the first report of SCBS using nerve transfer in patients with SCI in Thailand.